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1例抗精神病药恶性综合征患者的药学监护及文献复习
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| 篇名： | 1例抗精神病药恶性综合征患者的药学监护及文献复习 |
| TITLE： | Pharmaceutical Care of 1 Case of Neuroleptics-induced Malignant Syndrome and Literature Review |
| 摘要： | 目的：为抗精神病药恶性综合征（NMS）患者的个体化治疗提供参考。方法：对我院于2018年9月19日收治的1例NMS患者，临床药师全程提供药学监护，并提出用药建议；查阅文献，总结NMS的临床表现、危险因素、发病机制、鉴别诊断及治疗药物。结果与结论：临床药师结合患者抗精神病药物用药史、NMS特征性临床表现及实验室检查，提出该患者为NMS，医师采纳建议。在治疗过程中，临床药师针对患者入院前的用药情况和入院后医师的用药方案，建议停用亚冬眠合剂，改用甲磺酸溴隐亭片并行持续低温仪物理降温，用药疗程至少10d，医师采纳建议。用药第3天，患者症状开始缓解，第10天症状基本消失，并于第13天出院。文献复习结果显示，NMS的临床表现主要为高热、肌强直、精神状态改变、自主神经紊乱、磷酸肌酸激酶升高、白细胞增加等；危险因素包括药物因素、人口统计学因素、遗传因素等；发病机制可能与多巴胺能受体阻断及肌肉骨骼纤维毒性有关；鉴别诊断主要依据其临床表现，主要包括发病时间、神经肌肉反应性、缓解时间等；常用治疗药物为甲磺酸溴隐亭和丹曲林等。 |
| ABSTRACT： | OBJECTIVE：To provide reference for individualized treatment of patients with Neuroleptics-induced malignant syndrome（NMS）. METHODS ：A patient with NMS related to antipsychotics was admitted to our hospital in Sept. 19th 2018. Clinical pharmacists provided pharmaceutical care throughout the whole process ，and put forward suggestions for medication. Through literature review ，clinical pharmacists summarized the clinical manifestations ，risk factors ，pathogenesis，diagnosis and therapeutic drugs of NMS. RESULTS & CONCLUSIONS ：Based on the history of antipsychotic drug use ，the characteristic clinical manifestations of NMS and laboratory examination ，the clinical pharmacist proposed that the patient suffered from antipsychotic drug-related NMS ，and the doctor adopted the suggestions. In the course of treatment ，the clinical pharmacist suggested that the subhibernating mixture should be stopped ；Bromocriptine mesylate tablets should be used in combination with continuous hypothermia instrument for physical cooling ，and the treatment course should be at least 10 days according to drug use before admission and medication plan after admission. The doctor adopted the suggestion. The symptoms began to relieve on the third day ，and the symptoms basically disappeared on the 10th day ，then the patient was discharged on the 13th day. The clinical manifestations of NMS were high fever ，myotonia，mental state change ，autonomic nervous disorder ，creatine phosphokinase and leukocyte increase etc. ；risk factors included drug factors ，demographic factors ，genetic and etc. ；the pathogenesis may be associated with dopaminergic receptor block and musculoskeletal fiber toxicity ；the identification diagnosis was based on clinical manifestation，including the onset time ，neuromuscalar reactivity ，remission time ，etc.；the commonly used drugs were bromocriptine mesylate and dantraline. |
| 期刊： | 2020年第31卷第02期 |
| 作者： | 薛莹，司方莹，刘帅兵 |
| AUTHORS： | XUE Ying，SI Fangying ，LIU Shuaibing |
| 关键字： | 抗精神病药恶性综合征；药学监护；临床药师 |
| KEYWORDS： | Neuroleptics-induced malignant syndrome ；Pharmaceutical care ；Clinical pharmacist ；Liberature review |
| 阅读数： | 345 次 |
| 本月下载数： | 14 次 |
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